This may http://www.selleckchem.com/products/Tipifarnib(R115777).html limit the generalisability of the results. However, the size and the characteristics of the background population are known and the population is homogeneous, being 99% white Caucasian, with uniform financing within the healthcare system. In this prospective cohort study, we used the cumulative clinical information at the ED, which may lack systematisation but nevertheless is considered to reflect the routine operations of the ED, and the comprehensive population registries in a prospective design. Another limitation of this study is the sole use of the main diagnosis at discharge

from the ED, and we have only taken these diagnosis into account as an ever/never phenomenon. Many of the users of the ED surely also had other diagnoses than the main diagnosis, reported in the paper records not registered in the computerised records. Our procedure using only the main diagnosis does not ensure that

we have identified all patients with mental disorders, and so there is a possibility of residual confounding due to mental disorders. Nevertheless, the main diagnosis at discharge is considered to reflect the main clinical evaluation of the attending physician, taking into account the patient’s symptoms and his/her condition at the time of the visit.30 There is an inherent weakness in cohort studies comparing the mortality of severe cases of AUD with that of the general population, since the majority of those with AUD in the general population are undiagnosed and never receive treatment, as pointed out in the earlier discussion.2 The comparison group in these studies is contaminated with a considerable number of alcoholics, thus underestimating the mortality risk. Similar previous comparative studies, which are based on population surveys for AUDs, may also be handicapped due to a lack of accuracy in the diagnostic process (not clinical) and the fact that some of those

with alcohol dependency or misuse are in denial, and are not detected in the surveys, but remain in the Batimastat comparison groups. In accordance with this discussion, the increased mortality risk found in this study may also be an underestimation. In a sensitivity analysis we excluded patients with selected alcohol-related main diagnosis, such as alcohol poisoning (ICD-10 code T51), or alcohol liver disease (ICD-10 code K70), from the groups, and the HR did not change substantially, so the main results are not seriously underestimated for this reason. The patients in this study were confined to those discharged home from the ED after diagnostic workup and initial treatment. Patients visiting the ED, who were admitted to a hospital ward, may differ from those who were discharged home.